Evaluating the effect of driving distance to the nearest higher level trauma centre on undertriage: a cohort study

2021 ◽  
pp. emermed-2021-211635
Author(s):  
Job F Waalwijk ◽  
Robin D Lokerman ◽  
Rogier van der Sluijs ◽  
Audrey A A Fiddelers ◽  
Luke P H Leenen ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Emergency Medical Services ◽  
Resource Use ◽  
Severity Score ◽  
Injury Severity ◽  
Trauma Centre ◽  
Medical Services ◽  
Trauma Patients ◽  
Emergency Medical ◽  
Critical Resource

BackgroundIt is of great importance that emergency medical services professionals transport trauma patients in need of specialised care to higher level trauma centres to achieve optimal patient outcomes. Possibly, undertriage is more likely to occur in patients with a longer distance to the nearest higher level trauma centre. This study aims to determine the association between driving distance and undertriage.MethodThis prospective cohort study was conducted from January 2015 to December 2017. All trauma patients in need of specialised care that were transported to a trauma centre by emergency medical services professionals from eight ambulance regions in the Netherlands were included. Patients with critical resource use or an Injury Severity Score ≥16 were defined as in need of specialised care. Driving distance was calculated between the scene of injury and the nearest higher level trauma centre. Undertriage was defined as transporting a patient in need of specialised care to a lower level trauma centre. Generalised linear models adjusting for confounders were constructed to determine the association between driving distance to the nearest higher level trauma centre per 1 and 10 km and undertriage. A sensitivity analysis was conducted with a generalised linear model including inverse probability weights.Results6101 patients, of which 4404 patients with critical resource use and 3760 patients with an Injury Severity Score ≥16, were included. The adjusted generalised linear model demonstrated a significant association between a 1 km (OR 1.04; 95% CI 1.04 to 1.05) and 10 kilometre (OR 1.50; 95% CI 1.42 to 1.58) increase in driving distance and undertriage in patients with critical resource use. Also in patients with an Injury Severity Score ≥16, a significant association between driving distance (1 km (OR 1.06; 95% CI 1.06 to 1.07), 10 km (OR 1.83; 95% CI 1.71 to 1.95)) and undertriage was observed.ConclusionPatients in need of specialised care are less likely to be transported to the appropriate trauma centre with increasing driving distance. Our results suggest that emergency medical services professionals incorporate driving distance into their decision making regarding transport destinations, although distance is not included in the triage protocol.

Regional Health System Response to the 2007 Greensburg, Kansas, EF5 Tornado

2007 ◽  
Vol 1 (2) ◽  
pp. 90-95 ◽  
Author(s):  
Elizabeth Ablah ◽  
Annie M. Tinius ◽  
Kurt Konda ◽  
Carolyn Synovitz ◽  
Italo Subbarao
Keyword(s):  
Injury Severity Score ◽  
Emergency Medical Services ◽  
Severity Score ◽  
Injury Severity ◽  
Medical Services ◽  
System Response ◽  
Emergency Medical ◽  
Included Patient ◽  
Injured Patients ◽  
Regional Hospitals

ABSTRACTBackground: On May 4, 2007 an EF5 tornado hit the rural community of Greensburg, KS, destroying 95% of the town and resulting in 12 fatalities.Methods: Data was requested from the emergency medical services units that initially responded and the regional hospitals that received people injured in the tornado within 24 hours following the tornado. Requested data included patient age and sex, and injury severity score or ICD-9 codes. Critical mortality, or the number of deaths of critically injured patients, was also calculated.Results: The extensive damage caused by the tornado effectively destroyed the infrastructure of the community and created enormous challenges for emergency medical services responders, who were unable to record any triage data. Area hospitals treated 90 patients, who had an average injury severity score of 6.4. Age was found to be related to injury severity, but no relationship between sex and injury severity was found. Critical mortality was found to be 18% for this event.Conclusions: Injury severity score has seldom been used to analyze natural disasters, especially tornadoes, although such analysis is helpful for understanding the magnitude of the disaster, comparing to other disasters, and preparing for future incidents. Advanced warning and personal preparedness are important factors in reducing tornado-related injuries and deaths. (Disaster Med Public Health Preparedness. 2007;1:90–95)

Differences in Mortality Rates Among Trauma Patients Transported by Helicopter and Ambulance in Maryland

1999 ◽  
Vol 14 (3) ◽  
pp. 52-57 ◽  
Author(s):  
Walter A. Kerr ◽  
Timothy J. Kerns ◽  
Richard A. Bissell
Keyword(s):  
Injury Severity Score ◽  
Emergency Medical Services ◽  
Severity Score ◽  
Injury Severity ◽  
Medical Services ◽  
University Of Maryland ◽  
Emergency Medical ◽  
State Police ◽  
The Mean ◽  
The University

AbstractIntroduction:A comprehensive state wide emergency medical services and helicopter transport system has been developed in the State of Maryland on the principle that early definitive care improves patient out comes. The purpose of this study was to determine if empirical data exist to support the theory that air medical transportation services provided by the Maryland State Police (Maryland State Police) Aviation Division contribute to an improved trauma patient survival rate in Maryland.Methods:A retrospective study was conducted on the records of all patients transported by helicopter or ground ambulance and admitted to the R Adams Cowley Shock Trauma Center (R Adams Cowley Shock Trauma Center of the University of Maryland Medical System) of the University of Maryland Medical System. Data were obtained from the Maryland Institute of Emergency Medical Services Systems (Maryland Institute for Emergency Medical Services Systems) Shock Trauma Clinical Registry for the period January 1988 through July 1995, covering 23,002 patients. Patients included those transported directly from the scene of injury to the Maryland Institute for Emergency Medical Services Systems as well as those from interfacility transfers. All patients were stratified by injury severity and compared by outcome (mortality) using Mantel-Haenszel statistics.Results:During the study period, 11,379 patients were transported by ground and 11,623 were transported by Maryland State Police helicopter. The mean Injury Severity Score (Maryland State Police) for patients transported by ground was 12.7 (standard deviation = 12.52) and the mean Injury Severity Score for patients transported by air was 14.6 (Injury Severity Score = 13.42), p <0.001. Among patients classified as having a high index of injury severity, the mortality rate was lower among those transported by Maryland State Police helicopter than among those transported by ambulance. The mortality rate was significantly lower for air transported patient with an Injury Severity Score higher than 31.Conclusion:The State of Maryland has demonstrated a commitment to its citizenry and invested heavily in its public safety air medical service. This study suggests the rapid air transport of victims of traumatic events by specialized personnel in Maryland has a positive effect on the outcome of severely injured patients. Further research is necessary to clarify the causal relationships in order to more fully elucidate the value of this resource.

scholarly journals Study on patient satisfaction among patients with trauma admitted to trauma centre and emergency medical services ward

2019 ◽  
Vol 6 (4) ◽  
pp. 1219
Author(s):  
Mrutyunjay I. Uppin ◽  
Kapildev K. Hannurkar ◽  
Archana M. Uppin
Keyword(s):  
Patient Satisfaction ◽  
Emergency Medical Services ◽  
Trauma Center ◽  
Road Traffic ◽  
Trauma Centre ◽  
Medical Services ◽  
Research Centre ◽  
Trauma Patients ◽  
Quality Health Care ◽  
Emergency Medical

Background: Patient satisfaction is an important key factor for determining the quality health care and services offered by the emergency departments in the hospital. The objectives of the study were to assess the satisfaction of the trauma patients attending the trauma center with the services provided by the KLES Dr. Prabhakar Kore Hospital and Research Centre, Belagavi, Karnataka.Methods: Fifty trauma patients admitted and treated in trauma center and emergency medical services ward (TCEMS) at KLES Dr. Prabhakar Kore Hospital and Research Centre, Belagavi, over a period of 3 months (from November 2014 till January 2015) were interviewed. After obtaining an informed consent, the required data was collected using a pre-designed and pre-tested questionnaire.Results: Out of the 50 patients interviewed, 86% were males and 14% were females. Out of them 74% were road traffic accident victims. 67.5% of these victims were between the age group of 21 and 50 yrs. The overall satisfaction was good with all the services provided at the center. 80% were satisfied with the care provided by the doctors, 80% with communication by doctors, more than 75% with accessory services, more than 65% with the wait times at various levels and more than 85% satisfaction with amenities in the ward.Conclusions: In conclusion our study revealed that the availability of consultant in triage area, improvements in communication, quick service at the Casualty Pharmacy, reducing the perceived waiting times at various levels and improvement in the ambience of the unit would further enhance the patient satisfaction with TCEMS.

scholarly journals Priority accuracy by dispatch centers and Emergency Medical Services professionals in trauma patients: a cohort study

2021 ◽  
Author(s):  
Job F. Waalwijk ◽  
◽  
Robin D. Lokerman ◽  
Rogier van der Sluijs ◽  
Audrey A. A. Fiddelers ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Priority Setting ◽  
Injury Severity ◽  
Medical Services ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Reference Standard ◽  
Emergency Medical ◽  
Specialized Care ◽  
Primary Reference

Abstract Purpose Priority-setting by dispatch centers and Emergency Medical Services professionals has a major impact on pre-hospital triage and times of trauma patients. Patients requiring specialized care benefit from expedited transport to higher-level trauma centers, while transportation of these patients to lower-level trauma centers is associated with higher mortality rates. This study aims to evaluate the accuracy of priority-setting by dispatch centers and Emergency Medical Services professionals. Methods This observational study included trauma patients transported from the scene of injury to a trauma center. Priority-setting was evaluated in terms of the proportion of patients requiring specialized trauma care assigned with the highest priority (i.e., sensitivity), undertriage, and overtriage. Patients in need of specialized care were defined by a composite resource-based endpoint. An Injury Severity Score ≥ 16 served as a secondary reference standard. Results Between January 2015 and December 2017, records of 114,459 trauma patients were collected, of which 3327 (2.9%) patients were in need of specialized care according to the primary reference standard. Dispatch centers and Emergency Medical Services professionals assigned 83.8% and 74.5% of these patients with the highest priority, respectively. Undertriage rates ranged between 22.7 and 65.5% in the different prioritization subgroups. There were differences between dispatch and transport priorities in 17.7% of the patients. Conclusion The majority of patients that required specialized care were assigned with the highest priority by the dispatch centers and Emergency Medical Services professionals. Highly accurate priority criteria could improve the quality of pre-hospital triage.

Mode of Transport and Clinical Outcome in Rural Trauma: A Helicopter versus Ambulance Comparison

2017 ◽  
Vol 83 (12) ◽  
pp. 1413-1417 ◽  
Author(s):  
Mahdi Malekpour ◽  
Jabran M. Younus ◽  
Kathryn Jaap ◽  
Nina Neuhaus ◽  
Kenneth Widom ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Emergency Medical Services ◽  
Glasgow Coma Score ◽  
Injury Severity ◽  
Medical Services ◽  
Blunt Injury ◽  
Trauma Patients ◽  
Emergency Medical ◽  
Younger Men ◽  
Mode Of Transport

Helicopter Emergency Medical Services (HEMS) is presumably an effective way of patient transport in rural trauma, yet the literature addressing its effectiveness is scarce. In this study, we compared the clinical outcome of rural trauma patients between Ground Emergency Medical Services (GEMS) and HEMS transportation from the beginning of 2006 to the end of 2012. Focus was placed on identifying factors associated with survival to discharge in these patients. Over the seven-year study period, 4492 patients met the inclusion criteria with 2414 patients (54%) being transferred by GEMS and 2078 patients (46%) being transferred by HEMS. In comparison with GEMS, patients transferred by HEMS were younger men who were admitted with a higher mean Injury Severity Score and a lower mean Glasgow Coma Score (all Ps < 0.0001). HEMS patients were more frequently intubated before arrival at the trauma center (32% vs 9%, P < 0.0001) and were more frequently transferred to the operating room from the emergency department (11% vs 5%, P < 0.0001). In multivariate analysis, transfer by HEMS was associated with a significant increase in survival to discharge (odds ratio: 1.57, 95% confidence interval: 1.03–2.40, P = 0.036). Blunt injury, no intubation, and Glasgow Coma Score >8 were also associated with significantly improved odds of survival to discharge (all P < 0.0001). These findings show that although patients transferred by HEMS arrived in less favorable clinical conditions, HEMS transfer was associated with significantly higher odds of survival in rural trauma.

Injury Severity Score, Resource Use, and Outcome for Trauma Patients Within a Japanese Administrative Database

2010 ◽  
Vol 68 (2) ◽  
pp. 463-470 ◽  
Author(s):  
Kazuaki Kuwabara ◽  
Shinya Matsuda ◽  
Yuichi Imanaka ◽  
Kiyohide Fushimi ◽  
Hideki Hashimoto ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Resource Use ◽  
Severity Score ◽  
Injury Severity ◽  
Administrative Database ◽  
Trauma Patients

In-Hospital Outcome Based on the Mode of EMS Transportation in a High-Income Rapidly Developing Middle Eastern Country

2016 ◽  
Vol 9 (2) ◽  
pp. 246
Author(s):  
Hassan Al-Thani ◽  
Ayman El-Menyar ◽  
Yugan Pillay ◽  
Monira Mollazehi ◽  
Ahammed Mekkodathil ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Middle Eastern ◽  
Motor Vehicle Crash ◽  
Medical Services ◽  
Trauma Patients ◽  
Severe Injuries ◽  
Emergency Medical ◽  
The Impact

<p><strong>BACKGROUND:</strong> Helicopter emergency medical services (HEMS) are considered as a standard component of advanced pre-hospital emergency care system. We assessed the clinical presentation and outcomes of trauma patients transported by HEMS versus ground emergency medical services (GEMS).</p><p><strong>METHODS:</strong> A retrospective analysis of prospectively collected trauma registry data at a level I trauma center was conducted for patients transported by GEMS and HEMS between 2011 and 2013. Patients’ data were categorized and analyzed based on the mode of transportation (MOT).</p><p><strong>RESULTS:</strong> A total of 4596 trauma patients were admitted to the hospital with a mean age of 31±15 years. Injured patients were transported to the trauma centre by GEMS (93.3%) and HEMS (6.7%). The common mechanisms of injury were motor vehicle crash (37%) and fall (25%). MVC victims were transported to the hospital by HEMS, whereas, patients with fall and pedestrian injuries (P=0.001 for all) were more likely to be transported by GEMS. Moreover, patients in the HEMS group had a higher frequency of head (p=0.001) and chest (p=0.001) injuries and required prolonged ICU and overall hospital stay (p=0.001). When compared with GEMS, HEMS group were more likely to sustain severe injuries (ISS&gt;15; p=0.001) and needed frequent on-scene intubation (P=0.001). Hospital mortality was grater in HEMS patients (10% vs 4%, p=0.001) in comparison to GEMS. Multivariate analysis, after adjusting for the confounding factors demonstrated that polytrauma and lower scene GCS were the independent predictors of mortality.</p><p><strong>CONCLUSIONS: </strong>Patients transported by HEMS are characterized by greater injury severity, traumatic brain injury and on-scene intubation. Moreover, the mortality is 2.5 fold greater in patients transported by GEMS, however, the impact of MOT on mortality disappear after adjusting for potential confounders. Institutional guidelines that focus on clinical triage criteria, key environmental factors and reducing transport time may be informed by this study. Further investigations are needed to better quantifyestimate the pre-hospital time intervals and to identify the sub-groups of trauma patients who will clearly benefit from the use of HEMS.</p>

scholarly journals P095: Who, what, where: a critical assessment of helicopter emergency medical services transport and transfer times on patient outcomes at two level 1 trauma centres

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S110-S110
Author(s):  
B. Nolan ◽  
A. Ackery ◽  
H. Tien ◽  
B. Sawadsky ◽  
S. Rizoli ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Emergency Medical Services ◽  
Trauma Centre ◽  
Medical Services ◽  
Trauma Patients ◽  
Helicopter Emergency Medical Services ◽  
Trauma Centres ◽  
Emergency Medical ◽  
Level 1 ◽  
Mode Of Transport

Introduction: Helicopter emergency medical services (HEMS) have become an engrained component of trauma systems to expedite transportation to a trauma centre. Ornge is a provincially run, paramedic-staffed HEMS that is responsible for all air ambulance service within Ontario, Canada. They provide transportation for trauma patients through one of three ways: scene call, modified scene call or interfacility transfer. In this study we report the characteristics of patients transported by each of these methods to two level 1 trauma centres and assess for any impact on morbidity or mortality. Methods: A local trauma registry was used to identify all patients transported to our two trauma centres by HEMS over a 36-month period. Data surrounding patient demographic, arrival characteristics, transport times and in-hospital course were abstracted from the registry. Statistical analysis will be used to compare methods of transport and characterize any association between mode of transport and mortality. Results: From January 1st, 2012 to December 31st, 2014 HEMS transferred a total of 911 patients to our trauma centers with an overall mortality rate of 11%. Of these patients 139 were scene calls with a mortality rate of 8%, 333 were modified scene calls with a mortality rate of 14% and 439 were interfacility transfers with a mortality rate of 10%. Conclusion: Identifying any association between the type of HEMS transport and morbidity and mortality, we may be able to predict those that need more urgent transfer to a trauma centre and find ways to decrease our overall pre-trauma center time.

Non-Selective Thoracic Computed Tomography in Trauma Patients Results in Injury Severity Score Inflation

2021 ◽  
pp. 000313482110249
Author(s):  
Leonardo Alaniz ◽  
Omaer Muttalib ◽  
Juan Hoyos ◽  
Cesar Figueroa ◽  
Cristobal Barrios
Keyword(s):  
Computed Tomography ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Treatment Plan ◽  
Mortality Prediction ◽  
Trauma Patients ◽  
Mortality Benefit ◽  
Severity Scores ◽  
Score Inflation

Introduction Extensive research relying on Injury Severity Scores (ISS) reports a mortality benefit from routine non-selective thoracic CTs (an integral part of pan-computed tomography (pan-CT)s). Recent research suggests this mortality benefit may be artifact. We hypothesized that the use of pan-CTs inflates ISS categorization in patients, artificially affecting admission rates and apparent mortality benefit. Methods Eight hundred and eleven patients were identified with an ISS >15 with significant findings in the chest area. Patient charts were reviewed and scores were adjusted to exclude only occult injuries that did not affect treatment plan. Pearson chi-square tests and multivariable logistic regression were used to compare adjusted cases vs non-adjusted cases. Results After adjusting for inflation, 388 (47.8%) patients remained in the same ISS category, 378 (46.6%) were reclassified into 1 lower ISS category, and 45 (5.6%) patients were reclassified into 2 lower ISS categories. Patients reclassified by 1 category had a lower rate of mortality ( P < 0.001), lower median total hospital LOS ( P < .001), ICU days ( P < .001), and ventilator days ( P = 0.008), compared to those that remained in the same ISS category. Conclusion Injury Severity Score inflation artificially increases survival rate, perpetuating the increased use of pan-CTs. This artifact has been propagated by outdated mortality prediction calculation methods. Thus, prospective evaluations of algorithms for more selective CT scanning are warranted.

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